Echocardiography Guided Bed Side Balloon Atrial Septostomy In Dextro Transposed Great Arteries (Dtga) With Intact Ventricular Septum (Ivs): A Resource Limited Country Experience

Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy (BAS) in dextro transposition of great Arteries (dTGA) with intact ventricular septum (IVS) at a public sector tertiary care hospital Karachi, Pakistan.Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO (<= 2mm) who underwent bedside BAS at department of pediatric cardiology NICVD, Karachi, Pakistan. We recorded pre and post BAS diameter of PFO/Atrial Septal Defect (ASD), oxygen saturation (SpO(2)%), and post procedure complications and outcome.Results: Median age was 16 days, Majority of them (n=23, 58%) were severely cyanosed with SpO(2) of 41.4 +/- 3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO(2)% from 46.0 +/- 6% to 81.0 +/- 3.0% (p=<0.001) and ASD size from 1.4 +/- 2.8mm to 5.45 +/- 0.4mm was observed (p=<0.001). No complication was observed in most of cases (n=28, 70%). Mean hospital stay was 3.4 +/- 1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis.Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory.